By Jaclyn Guliano, MD
Each child develops differently, both mentally and physically. An annual wellness checkup by a board-certified physician can detect medical and behavioral health issues early, keep immuni- zations up to date, and provide an opportunity for both you and your child to ask the doctor about any concerns you have.
Pediatricians vs. Family Medicine Physicians
Wellness visits can be conducted by your child’s pediatrician or by a family medicine physician. Family medicine physicians are trained in pediatrics and obstetrics, and care for patients of all ages, from newborns to seniors.
What to Expect During an Annual Checkup
Wellness checkups typically are tailored to your child’s age and developmental stage. For example, if I’m examining an infant, I’ll measure her head circumference, while if I’m seeing an adoles- cent, I’ll review his body mass index (BMI) to ensure that he’s maintaining a healthy weight for his frame.
In general, a wellness exam will cover:
• Height and weight measurements
• Growth milestones and how they compare with appropriate growth charts
• Developmental milestones
• Vital signs, including blood pressure and heart rate
• Eating habits
• Exercise habits
• Behavioral issues
The visit also will include a comprehensive physical exam. In general, the physician will examine your child’s: • Eyes and perform a vision screening (with corrective lenses if needed)
• Ears, looking for excessive earwax, infections, perforated ear drums or items in ears (it happens!)
• Nose, checking for polyps or septum deformities
• Throat and mouth, looking at the tonsils, back of the throat and tongue (which can signal dehydration) and checking the teeth
• Heart, checking for abnormal sounds such as murmur or abnormal rate or rhythm • Lungs, checking for abnormal breath sounds
• Abdomen, feeling for masses or areas that are painful when touched
• Genital exam, to ensure your child is developing normally
• Skin, looking for rashes or skin lesions
He or she also will perform a musculoskeletal exam to determine strength and stability. They will check and examine for any gait abnormalities, abnormal spine curvature, and your child’s ability to follow directions, for example seeing if your child can jump on one foot.
What You Should Bring
Open lines of communication – and information – are important. Be sure to bring or be ready to provide information about:
• Medication history
• Vaccination history
• Family medical history
• Blood test results
• Surgical records
• Radiology studies, like X-rays
• Physical, occupational or behavioral health therapy • Allergies
• Questions you or your child have
It’s important that whoever brings your child to his or her appointment knows the child’s medical and vaccination history as well.
Early Screening Means Early Detection – and Intervention
It may be tempting to skip these visits if your child is generally in good health, but they are a good way to keep your child’s doctor informed about your child’s progress. Because these visits focus on total body wellness, as opposed to just examining your child’s ears, nose and throat when he or she has a cold, we can pick up potential problems before they become emergen- cies, such as a heart murmur.
For younger patients, I use an autism screening tool called M-CHAT, or Modified Checklist for Autism in Toddlers. It’s a scientifically validated tool for children between 16 months and 30 months of age that assesses a child’s risk for autism spec- trum disorder (ASD). If we suspect that a child is showing signs of ASD, we can refer him or her for further assessment by a specialist. It’s also an important tool for raising a parent’s awareness and providing education about a potential concern. If needed, a child can be referred to specialized services, like speech therapy or occupational therapy.
Staying up to date on immunizations is another important benefit to wellness visits. Not only does it help decrease your child’s risk of contracting communicable diseases, it also is a requirement for certain school programs and sports. By keeping your child’s immunizations current, you are not only giving them the best protection against disease, but also avoiding having to rush to the doctor’s office for a shot or delaying your child’s participation in an important activity.
I also use wellness visits as an opportunity to review health issues like car seat safety, sun safety, water safety and bullying, depending on the age of the patient.
How to Calm a Fearful Child
A previous doctor visit that was traumatic for your child or even fear of the unknown may make him or her anxious and upset about seeing the doctor. I encourage my adult patients to bring their chil- dren to their own visits so the child will see that mom or dad isn’t afraid of the doctor. It also helps me build a relationship with the child in a relaxed setting, since they aren’t the subject of the visit. And, if your child had a tearful experience during a vaccination, a soothing spray can help make the experience less unpleasant.
I’ve also found that kids who watch “Doc McStuffins” seem to be less stressed about doctor visits. During the animated TV show, 6-year-old Dottie “Doc” McStuffins treats stuffed animals and toys in her imaginary playhouse clinic. The program shows kids that the doctor’s office isn’t a scary place.
Your child’s health and wellness can impact physical development,
school performance and behavior. Annual visits are an important opportunity to ensure your child is thriving and feeling his or her best.
Jaclyn Guliano, MD, is a board-certified family medicine physician on staff at CentraState Medical Center. She can be reached by calling 866-CENTRA7.